Author(s): Zhao S.S.; Duffield S.J.; Moots R.J.; Goodson N.J.; Yoshida K.; Tedeschi S.K.; Solomon D.H.; Jones G.T.; Hughes D.M.; Lyu H.
Source: Arthritis Research and Therapy; Jul 2019; vol. 21 (no. 1)
Publication Date: Jul 2019
Publication Type(s): Article
Available at Arthritis Research and Therapy – from BioMed Central
Available at Arthritis Research and Therapy – from SpringerLink – Medicine
Available at Arthritis Research and Therapy – from Europe PubMed Central – Open Access
Available at Arthritis Research and Therapy – from DOAJ – Directory of Open Access Journals
Available at Arthritis Research and Therapy – from EBSCO (MEDLINE Complete)
Available at Arthritis Research and Therapy – from Unpaywall
Abstract:Background: The impact of smoking on TNF inhibition (TNFi) therapy is unclear. We examined the effect of smoking on all-cause and cause-specific TNFi discontinuation in axial spondyloarthritis (axSpA). Method(s): We used longitudinal data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Patients fulfilling the ASAS criteria for axSpA, who started their first TNFi, were eligible for analysis. Inverse-probability weights were used to balance differences in baseline disease severity and other confounders. We used marginal structural Cox proportional hazard models to estimate hazard ratios (HR) for TNFi discontinuation according to smoking status. In analyses of cause-specific discontinuation, competing risk events were considered as censoring, using inverse-probability weights. Result(s): A total of 758 participants were included in the analysis (66% male, mean age 45 years), providing 954 patient-years of follow-up. TNFi was discontinued in 174 (23%) patients, among whom 26% stopped due to infections, 20% due to other adverse events and 44% due to inefficacy or other reasons. Thirty-four percent were current smokers and 30% ex-smokers. Compared to never smokers, current smokers’ risk of TNFi discontinuation was HR 0.79 (95%CI 0.53 to 1.20) and ex-smokers HR 0.68 (95%CI 0.45 to 1.04). Our data did not show evidence that current smoking influenced discontinuation due to infections (HR 0.79, 95%CI 0.40 to 1.54), other adverse events (HR 0.86, 95%CI 0.41 to 1.78) or inefficacy/other causes (HR 1.44, 95%CI 0.86 to 2.41). Conclusion(s): Baseline smoking status did not impact TNFi discontinuation in this UK cohort of axSpA participants.
Copyright © 2019 The Author(s).
Database: EMBASE